ABSTRACT
Objective To study the effect of urodynamic factors on the urinary retention of the patients with cervical cancer received radical hysterectomy. Methods Seventy-two patients with cervical cancer Ininternational Federation of Gynecology and Obstetrics (FIGO) stage Ⅰ bl to Ⅱ a hospitalized in Fujian Provincial Maternity and Child Health Hospital between June 2006 and August 2009, who were not found any abnormal representation of urodynamics before the operation, were divided into the group with urinary retention and the group without urinary retention based on whether urinary retention after the operation. All patients were detected by urodynamic examination following radical hysterectomy. Data obtained from urodynamic examination were analysed by logistic regression to evaluate the influence of urodynamic factors on the urinary retention postoperation. Results Twenty-one patients out of all were found with urinary retention after the operation , the incidence rate of urinary retention was 29%. The first sensation after operation in both groups were increased significantly than those before operation[ ( 171 ±61 )ml vs.(126 ±28)ml, (134±39)ml vs. (119 ± 17)ml,all P＜0.05], while the maximum volume[ (337 ±66) and (300 ±66)ml, respectively], the compliance[ (31 ±25) and (29 ± 18) ml/cm H2O (1 cm H2O =0. 098 kPa), respectively], the maximum flow rate[ (10 ±4) and (12 ±5) ml/s, respectively] and the pressure at the maximum flow rate [ (27 ±9) and (32 ±8) cm H2O, respectively] were decreased obviously after radical hysterectomy in both the group with urinary retention and the group without urinary retention ( all P ＜0.05), compared with the corresponding value before the operation. The urodynamic changes in urinary retention group was much more severe than those in group without urinary retention ( P ＜ 0. 05 ). The single factor analysis results showed that bladder destusor dysfunction ( OR = 8. 20, 95% CI: 2.62 - 25. 66, P ＜0. 01 ) and lack of sensation ( OR = 6. 90, 95% CI: 1.95 - 24. 43, P ＜ 0. 01 ) were relevant to the urinary retention post-operation. While there were not relationship was found between low compliance bladder( OR =1.99, 95% CI:0. 70 - 5.63, P = 0. 195 ), detrusor overactivity ( OR = 2. 51, 95% CI: 0. 73 - 8.67, P =0. 144), bladder outlet obstruction ( OR = 3.77, 95% CI: 0. 76 - 18. 57, P = 0. 104 ) or dyssynergia of urethral external sphincter( OR =2. 67, 95% CI:0. 49- 14. 45, P =0. 255 ) and urinary retention following the operation. There were an antagonistic effects ( OR = 7.60, 95% CI: 1.43 - 40. 39, P = 0. 017 ) of detrusor overactivity and bladder destrusor dysfunction on urinary retention. The multiple factors analysis results revealed that bladder destusor dysfunction( OR = 7.01, P ＜ 0. 01 ) and lack of sensation( OR = 5.45, P =0. 018)were the independent risk factors influening on the urinary retention post-operation. Conclusions There are obvious urodynamic change in cervical cancer patients following radical hysterectomy. Bladder destrusor dysfunction and lack of sensation are the independent urodynamic risk factors influencing on urinary retention following radical hysterectomy, while detrusor over activity may be a protective effect on bladder destrusor dysfunction post-operation in some degree. Urodynamic test is important for analysis and treatment of urinary retention following radical hysterectomy.
ABSTRACT
Objective:To study the variation of recent bladder function of the patients who received radical hysterectomy and evaluate its significance. Methods:Sixty-three patients with cervical carcinoma in International Federation of Gynecology and Obstetrics(FIGO) stage IB1 to ⅡA received urodynamic examination before and after operation. The urodynamic parameters included filling cystometry, pressure-flow rate, and electromyography of sphinctienter. Results:Radical hysterectomy induced significant increase in the first sensation (P<0.01)and post voiding residual of bladder (P<0.01) ;whereas caused significant decrease in the maximum volume(P<0.01), compliance(P<0.01),maximum flow rate(P<0.01) and the pressure at the maximum flow rate(P<0.01), respectively, compared with the corresponding values before the operation. Short-term bladder dysfunctions were observed in 34 patients (54.0%) including bladder detrusor dysfunction, low compliance bladder, bladder outlet obstruction, dyssynergia of urethral external sphincter and detrusor overactivity. The incidences of low compliance bladder and bladder detrusor dysfunction increased significantly after operation (P<0.01). Urinary retention was found in 28.6%(18/63) patients. The incidences of bladder detrusor dysfunction (66.7% vs 20.0%) and detrusor overactivity (33.3% vs 4.4%) in the group with urinary retention were significantly higher than those of corresponding group without urinary retention. Conclusion:The bladder function had obvious short-term changes following radical hysterectomy. In the many types of bladder dysfunction the main dysfunctions were low compliance bladder and bladder detrusor dysfunction. The bladder detrusor dysfunction might be the major cause of the urinary retention following the surgery. Urodynamic test was important for post-operative analysis and treatment of bladder dysfunction.